Mainstreaming Opioid Maintenance Treatment into General Medicine: Effects on Addi

说明(由申请人提供)：在美国，由于阿片依赖的种族和社会经济地位，在获得布丙诺芬维持服务方面存在差异[1]，这就提出了这样一个问题：照护系统中未被承认的污名和边缘化是否会加剧治疗中的不平等，因为上瘾在私人部门被临床视为一种慢性疾病，并被纳入以办公室为基础的做法[2]。该项目调查了将阿片依赖的丁丙诺芬维持治疗纳入普通医学诊所的主流对患者的耻辱和社会网络的影响。它侧重于为低收入和少数民族患者提供服务但采用丁丙诺芬治疗缓慢的公共诊所，还审查了机构和专业对提供者采用丁丙诺芬的影响。该项目使用了混合的社会科学研究方法，并将涉及诊所的观察性案例研究、半结构化访谈、感知耻辱的纵向测量和社会网络分析。这些工作将在五家诊所进行，这些诊所因环境(普通药物与药物滥用专业)、患者人口统计(种族和社会经济地位)以及诊所工作人员采用丁丙诺芬维持的速度而有所不同。通过对广泛健康状况的治疗技术传播的研究，可以预测在美国获得布丙诺芬的差异，这些研究表明，改进的技术往往扩大了优势和弱势患者群体之间的治疗差距[3]，在心理健康和成瘾的情况下，对弱势群体的污名产生不同的影响[4，5，6]。该项目旨在阐明治疗和结果的制度和社会经济决定因素，重点是污名和社会资源与临床环境(普通药物与药物滥用诊所)和患者人口统计的关系。因此，该项目解决了国立卫生研究院的一个核心目标，即减少获得医疗保健方面的差距。

DESCRIPTION (provided by applicant): Disparities in access to buprenophine maintenance for opioid dependence by ethnicity and socioeconomic status in the U.S. [1] raise the question of whether unrecognized stigma and marginalization within systems of care will intensify inequities in treatment, as addiction is clinically treated as a chronic medical illness in the priate sector, and integrated into office-based practices [2]. This project investigates the influence of mainstreaming buprenophine maintenance treatment for opioid dependence into general medicine clinics on the perceived stigma and social networks of patients. Focusing on public clinics that serve low income and ethnic minority patients, but have been slow to adopt buprenophine treatment, it also examines institutional and professional influences on buprenophine adoption by providers. The project uses mixed social science research methods, and will involve observational case studies of clinics, semi-structured interviews, longitudinal measures of perceived stigma, and social network analysis. These will be undertaken in five clinics that vary by setting (general medicine versus substance abuse specialty), patient demographics (ethnicity and socioeconomic status), and the speed with which clinic staff adopt buprenophine maintenance. Disparities in access to buprenophine in the U.S. are predicted by studies of technology dissemination of treatment for a wide range of health conditions, which demonstrate that improved technologies often widen treatment gaps between advantaged and disadvantaged patient groups[3], and in the case of mental health and addiction, affect stigma differently among disadvantaged groups[4,5,6]. This project seeks to illuminate institutional and socioeconomic determinants of treatments and outcomes, with a focus on the relationship of stigma and social resources to clinical setting (general medicine versus substance abuse clinic) and patient demographics. This project thereby addresses a core NIH goal of reducing disparities in access to health care.